Decompressive craniectomy is a measure in the management of intracranial hypertension due to injuries that dont respond to initial measures. cranial defects may present multiple complications associated with management. Atmospheric pressure generates a force on adjacent brain parenchyma, conditioning dynamic alterations in cerebral and cerebrospinal flow.

Fulminant streptococcal infection with early immunoglobulin introduction resulting in a favourable outcome for both mother and new-born: A case reportTakanori Sato, Rie Oyama, Tsukasa BABADepartment of Obstetrics and GynecologyIwate Medical University2-1-1 Ididori, Yaba-cho, Shiwa-gunIwateTel: 81-19-613-7111028-3695, JapanCo-author: Rie Oyama.E mail: oyamariegm@gmail.comRunning title: Successful treatment of STSS with immunoglobulinCase reportStreptococcal toxic shock syndrome (STSS) is Group A Streptococcus infection that causes rapidly progressive sepsis, disseminated intravascular coagulation (DIC), and multiple organ failure. STSS is the most common cause of sepsis-related maternal mortality1. Early diagnosis and intervention are important, but few reports on immunoglobulin as an adjunctive therapy. The cytokine production is elevated during pregnancy2, suppressing the cytokine storm is more important in sepsis caused by STSS in pregnant women than non-pregnant women, and anti-inflammatory immunoglobulin will likely be useful as an adjunctive therapy to improve maternal and infant prognosis. We report a case of STSS possibility treated using antimicrobial agents and immunoglobulin as adjuvant therapy. This patient of case report provided informed consent. We report a case of the potential of STSS treated with antibiotics and immunoglobulins as adjuvant therapy, and indicate the mechanism of effect of immunoglobulins on cytokine storm.A 37-year-old pregnant woman (gravid 5, para3) woman with a history of WPW syndrome and chronic thyroiditis. The patient had sore throat and fever of 39 °C on 32 +1 weeks, who was admministred in our hospital. At 32 + 4 weeks, her blood pressure and pulse were 79/48 mmHg and 140bpm, SpO2, 98% (oxygen mask, 6 L/min). Cardiotocography revealed delayed transient bradycardia, and we suspected septic shock and foetal insufficiency. Blood tests: WBC 14,740/μL, platelet 9.2 ×104/μL, C-reactive protein 11.1 mg/dL. Her qSOFA score: 1 (respiratory rate: >22 breaths/min), but her National Early Warning Score was 9 (respiratory rate, ≥25; oxygen demand, systolic blood pressure 101-110, heart rate ≥131/min), which is a warning value and corresponds to symptoms of sepsis due to STSS. Therefore, the antimicrobial agent was changed from cefepime to a combination of piperacillin and clindamycin, and an emergency caesarean section was performed 3 houre after admmited at our department. The baby was 2320 g, Apgar score, 1points/3 points (1 minute/5 minutes),umbilical artery blood pH 7.28. Obstetric DIC score was 3 points. Placental histopathology revealed stage 1 chorioamnionitis, but noGroup A streptococcal aggregation in the interchorionic space. On the second postoperative day, we were informed that Group A Streptococcus was detected in pharyngeal and blood cultures at the previous hospital, and antibacterial therapy with piperacillin and clindamycin for STSS and immunoglobulin were continued. Noradrenaline was also started as she had trouble maintaining her blood pressure on the first postoperative day, and dobutamine was added on the third postoperative day. On the fourth postoperative day, her respiratory condition worsened and bilateral diffuse frosted glass shadows were observed on chest radiography. Bilateral pleural effusions and pleural thickening were observed on computed tomography. Respiratory therapy with nasal high flow (NHF) was initiated. The patient was weaned from the NHF and switched to nasal cannula oxygenation on postoperative day 7. Oxygen administration was discontinued on postoperative day 15, and the patient was discharged on postoperative day 21 with improved bilateral diffuse frosted margins on chest radiographyDiscussionIn this case, STSS developed during pregnancy, but early delivery of the baby, antimicrobial therapy, and concomitant use of immunoglobulin from the early postoperative period onward resulted in a good outcome for both the mother and baby. In the field of obstetrics, perinatal STSS was described as “a condition that develops in pregnant women in the last trimester of pregnancy due to hematogenous myometrial infection mainly originating from the upper respiratory tract that induces labour pain and rapidly progresses to septic shock, resulting in a high rate of foetal and maternal death” in 20013,4. There is a trend toward poor prognosis for both the mother and new-born. In Japan, 24 (7.5%) of 317 maternal deaths were due to sepsis, and 13 (53.4%) were due to Group A Streptococcus infection between 2010 and 2016. A 2019 proposal by the Division of Medical Safety of the Japanese Society of Obstetricians and Gynaecologists stated that a modified Centor score should be used for pregnant women to facilitate early medical intervention and reduce maternal deaths due to STSS5. Penicillin and clindamycin are the basic antimicrobial agents of choice for STSS, and combinations containing clindamycin effectively suppress exotoxins and TNF-α and promote phagocytosis by inhibiting M-protein synthesis6,7. Meta-analysis reported that adjunctive immunoglobulin administration was associated with a significant reduction in mortality in STSS patients treated with clindamycin in 20188.The mechanisms of cytokine production and perinatal STSS are shown in Figure 1. Antigens are normally absorbed by antigen-presenting cells, fragmented into peptides, then recognised by T-cell receptors via the major histocompatibility complex (MHC) class II, which activates T cells. In contrast, superantigens bind directly to MHC class II and T-cell receptors without being taken up by antigen-presenting cells and produce numerous cytokines9,10, causing a marked inflammatory reaction via exotoxin11 and leading to septic shock. The production of cytokines such as TNF and IL-1β is also elevated during pregnancy due to changes in monocyte subsets13, and cases of perinatal STSS are prone to cytokine storms.Immunoglobulins exert effects similar to those of opsonin, along with phagocytosis-promoting, superantigen-neutralizing, anti-inflammatory, and antibody-dependent cytotoxic effects, and suppresses proinflammatory cytokine production11,13,14. Immunoglobulins have become a standard anti-inflammatory therapy for Kawasaki disease15. In this case, maintaining blood pressure became difficult on the first postoperative day, and noradrenaline was initiated along with immunoglobulin to suppress the cytokine storm caused by perinatal STSS. Procalcitonin levels were elevated the day after the culture results were obtained from the previous physician (postoperative day 3), but quickly decreased thereafter, and immunoglobulin was discontinued on postoperative day 4. Procalcitonin is produced by endotoxins and proinflammatory cytokines such as TNF-α, IL-1, and IL-6 in cases of severe bacterial infection16,17, and thus indirectly reflects the inflammatory state in the body. Procalcitonin may be an indicator of inflammation reflecting hypercytokinemia in cases of Kawasaki disease, and effectively predicts immunoglobulin refractoriness18. In this case, the reduction in procalcitonin levels following concomitant immunoglobulin use reflected STSS control and cytokine storm suppression, suggesting that the concomitant use of immunoglobulin may have been effective.In this study, we encountered a case of a mother and infant whose lives were saved by delivering the infant early, combined with the use of maternal antimicrobial therapy and combined immunoglobulin administration. The usefulness of combined immunoglobulin administration in perinatal STSS should be studied to further improve maternal and infant prognosis.

The repair of severe bone defects is still a formidable clinical challenge, requiring the implantation of bone grafts or bone substitute materials. The development of three-dimensional (3D) bioprinting has received considerable attention in bone tissue engineering over the past decade. But 3D printing has a limitation. It only takes into account the original form of the printed scaffold, which is inanimate and static, and is not suitable for dynamic organisms. With the emergence of stimuli-responsive materials, four-dimensional (4D) printing has become the next generation solution for biological tissue engineering. It combines the concept of time with three-dimensional printing. Over time, 4D printed scaffolds change their appearance or function in response to environmental stimuli (physical, chemical and biological). In conclusion, 4D printing is the change of the fourth dimension (time) in 3D printing, which provides an unprecedented potential for bone tissue repair. In this review, we will discuss the latest research on shape memory materials and 4D printing in bone tissue repair.

Borderline ovarian Brenner tumors are rare, mainly diagnosed manopause. We reported in a previous article the first pregnancy after a fertility sparing surgery. We now report the first baby birth after unilateral salpingo-oophorectomy for a borderline ovarian Brenner tumor and a review of the literature on fertility sparing surgery.

Beeing a life-threatening and rare event, we present here a nosocomial Pseudomonas aeruginosa meningitis after spinal anaesthesia treated effectively with the combination of Cefoperazone/Sulbactam and Ciprofloxacin. These drugs could be a therapeutic alternatives to treat this life threatening disease, especially in low income countries where reference treatments are unavailable.

Bipolar Ablation for Outflow Tract Ventricular Arrhythmias: When the Going gets Tough, Two Catheters may be Better than One Anurut Huntrakul, MD1,2 and Jackson J. Liang, DO11 Electrophysiology Section, Division of Cardiology, Cardiovascular Center, University of Michigan Medical Center, Ann Arbor, MI 48109, USA.2 Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Bangkok 10330, ThailandFunding: NoneDisclosures: None

We aimed to focus on clinical features, on diagnosis of this pathology and to review the most controversial aspect of management. We reviewed 10 in patients between 1995 and 2020. All patients were treated with broad-spectrum antibiotherapy, anticoagulation in 9 patients, and surgery required in 9 patients.

In this paper, we will derive the minimum-norm solution, the least-squares solution, and the optimal approximation solution for the elliptic complex matrix equation AXB = D by using the real representation of elliptic complex matrices and the Kronecker product of matrices. Moreover, we present a numerical example to show the correctness of our results.

The mechanisms that restrict gene flow between populations and facilitate population differentiation and speciation vary across the tree of life. In systems where physical barriers to gene flow are dynamic over time and space, such as many marine species, introgression may be a major factor in the speciation process. In sympatric species of seabirds with no land barriers between them, hybridization has been frequently observed but few studies have investigated patterns of introgression. We used whole-genome sequence data to test for interspecific introgression between five pairs of tropical and subtropical seabirds and to test for gene flow within species across major land masses and ocean basins. We found evidence for introgression between blue-footed (Sula nebouxii) and Peruvian boobies (S. variegata); masked (S. dactylatra) and Nazca boobies (S. granti); and blue-footed and Nazca boobies. We found no evidence of introgression between blue-footed and brown boobies (S. leucogaster) and masked and brown boobies despite observed hybridization between these species. We also found evidence for gene flow across several major land masses in three pantropical species: red-footed (S. sula), brown, and masked boobies. Finally, we report evidence for ancient introgression between brown boobies and the ancestor of blue-footed, Peruvian, masked, and Nazca boobies. Our work indicates (1) that interspecific introgression has shaped contemporary booby diversity in the eastern Pacific, and (2) that contemporary physical barriers to gene flow between booby colonies are not impenetrable. Our findings contribute novel insights to the growing body of evidence that suggests introgression is a widespread evolutionary process.

Background: Manifestations of food allergies vary among patients, being the most common gastrointestinal, skin and respiratory symptoms. This study aimed to identify and characterize polyp Th2 cells as a critical component of the allergic reaction. We previously characterized colorectal polyps in patients sensitized to food allergens as inflammatory, with a Type 2-dominated stroma, with elevated IL-13, IL-4 and locally synthesized IgE. Methods: We isolated milk-specific T cells from tissue and blood of food-sensitized patients (n=10) and obtained cell lines and cell clones. Proliferation, specificity, cytokine secretion, gut homing markers and TCR nature were analyzed after antigen recall; CCL25 was assessed in polyps and surrounding tissue. Results: Lamina propria and peripheral T cells responded similarly to cow´s milk proteins, showing similar cell proliferation index and Th2 cytokine release in vitro. All CD4 + T cells expressed the membrane T αβ receptor and secreted higher IL-13 amounts than unstimulated cells, whereas IFN-γ secretion remained unchanged. Remarkably, the gut homing chemokine receptor CCR9 was augmented in cow’s milk-specific peripheral and lamina propria T cells, and CCL25 was found to be expressed in the inflammatory polyp tissue and not in the adjacent mucosa. Conclusion: We isolated and characterized cow´s milk-specific lamina propria CD4 + TCRαβ + Th2 cells from colonic inflammatory polyps. The CCR9 expression on polyp cells and the increased production of tissue CCL25 might facilitate T cells’ recruitment, which are key players in the allergic reaction to promote local IgE synthesis. Our findings may be critical to proposing rational and novel T cell-targeted immunotherapies.

Boost converter is widely used in DC power supply system. Its input voltage is often provided by AC power grid through an uncontrolled rectifier bridge. Due to that, there is obvious double-line frequency ripple especially in DC input voltage and inductor current. To solve this problem, a PI regulator with DC input voltage prediction is proposed in this letter. The reference duty cycle is calculated by a PI regulator, and then it is modified by the prediction. To predict well, the quadratic interpolation method with error correction is adopted. The effectiveness of the proposed method on double-line frequency ripple suppression is verified by experimental results.

The classification of modulated signals under a low signal-to-noise ratio (SNR) environment has become a hot topic due to the complexity of the communication environment. Many relevant publications deal with signal recognition with stable SNR but are not applicable in time-varying SNR scenarios. To solve this problem, we propose a new method for determining the types of modulation based on entropy analysis. The proposed algorithm first extracts characteristics using different types of entropy and can separate the types of phase modulation (PSK): BPSK, QPSK, 8PSK, 16PSK, 32PSK, and 64PSK. In comparison with traditional feature extraction methods, the proposed algorithm increases the efficiency of signal classification. The results show that the algorithm can achieve better signal classification effects, even if SNR reaches -4 dB.

In this study, gallic acid was separated by triphenylphosphine oxide in the presence of conventional solvents. Triphenylphosphine oxide is an organophosphorus extractant and highly selective towards carboxylic acids. Reactive extraction results were compared with physical extraction results. The extraction efficiencies reached up to 61, 76, 86, 67, and 84 % in the presence of triphenylphosphine oxide with oleyl alcohol, dimethyl adipate, isobutanol, methyl isopropyl ketone, and methyl ethyl ketone, respectively. Further, the number of theoretical units and the solvent to feed ratio were calculated for the practical design of a liquid-liquid extraction column. Roughly 2 to 4 theoretical units were calculated to meet the targeted extraction efficiencies. Gradient boosting algorithm showed a good performance to predict the results. This study is the first to investigate the reactive extraction of gallic acid by triphenylphosphine oxide, and include fundamental information for the recovery of gallic acid.

An economical and highly uranium extraction from seawater remains a crucial task for energy sources and environmental safety. Aiming for improving the mass transfer rate of uranium from seawater, a new synthetic strategy was adopted to synthesize 2D-open channel microporous bio-adsorbent for uranium extraction from seawater. Herein, a vapor phase modification approach was adopted to graft divinylbenzene(DVB), and polyacrylonitrile(AN) onto the surfaces of microporous frameworks via a free radical polymerization method. The post-synthetic functionalization was carried out by hydrothermal process, where amidoxime groups are structure-directing agents to trap uranium. Further, amidoxime groups not only enhanced hydrophilicity but also adjusts adsorbents pKa. AO-Fc faces minimum interference of competing ions and achieves a high uranium adsorption capacity of 8.57±0.02 and 409±1 mg/g in seawater and simulated solution. Despite its stable structure, AO-Fc exhibits a long life span and negligible weight loss revealed AO-Fc could be applied as a potential adsorbent for radionuclides

BACKGROUND: Recent pharmacoepidemiology data show an increase in the proportion of patients receiving second-generation antipsychotic (SGA) monotherapy, but no studies have analyzed the same patients over a long period of time. Therefore, in this study, we decided to evaluate retrospectively schizophrenia patients with available data for 20 years to see whether the drug treatments in the same patients have changed in the past 20 years. METHODS: The study began in April 2021 and was conducted in 15 psychiatric hospitals in Japan. Schizophrenia patients treated in the same hospital for 20 years were retrospectively examined for all prescriptions in 2016, 2011, 2006, and 2001 (i.e., every 5 years). RESULTS: The mean age of the 716 patients surveyed in 2021 was 61.7 years, with 49.0% being female. The rate of antipsychotic monotherapy use showed a slight increasing trend over the past 20 years; the rate of SGA use showed a marked increasing trend from 28.9% to 70.3% over the past 20 years, while the rate of SGA monotherapy use showed a gradual increasing trend over the past 20 years. The rates of concomitant use of anticholinergics, antidepressants, anxiolytics/sleep medications, and mood stabilizers showed decreasing, flat, decreasing, and flat trends over the past 20 years, respectively. CONCLUSION: The results of this study showed a slow but steady substitution of SGAs for first-generation antipsychotics (FGAs) over time, even in the same patients.

The severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2), etiological agent of the novel coronavirus disease 2019 (COVID-19), has spread since December 2019, resulting in massive health and economic crisis worldwide. While efforts to stop the pandemic are crucial, collecting epidemiological data to help manage current and future pandemics will be important. In addition to humans, serological and molecular based studies have demonstrated SARS CoV-2 exposure in several wild, domestic and farmed animals. For examples Shriner and the team showed serologically an exposure of 40% to the white deer living in close proximity to urban centers. Additional reports have also emerged of susceptibility of animal’s species like cats, ferrets, raccoon dogs, cynomolgus macaques, rhesus macaques, white-tailed deer, rabbits, Egyptian fruit bats, and Syrian hamsters to SARS-CoV-2 infection.. It’s worth emphasizing that these reports are based on experimental data mostly derived from Europe, USA, South America and parts of Asia. In limited instances natural infections of SARS-CoV-2 have been reported in pet dogs, cats, tigers, lions, snow leopards, pumas, gorillas at zoos and farmed mink and ferrets. The presence of the virus in animal species and an understanding of whether these are natural or recent human to animal transmissions is important. It’s possible that such transmission could passage the virus or subject the virus to a different immunological pressure thereby helping with the development of viral variants in addition to being a host for future reservoirs of the virus. In Kenya SARS-CoV-2 was first detected on March 12 th 2020 from imported human cases of persons who had travelled from the United States. This was followed by detection of imported cases majorly from China, Sweden and United Kingdom. Later infections were confirmed in Nairobi and Mombasa suggesting further cases of disease importations through the major ports of entry. However, no comparable data on animal exposure have hitherto been generated in Kenya. To address this key concern, we focused on three objectives; 1) development of a robust antibody ELISA based on crude SARS-CoV-2 lysate. 2) SARS-CoV-2 serology of domestic animals in Kenya. 3) Corroboration of the crude lysate based seroprevalence data and a commercial ELISA kit based on the Spike receptor binding domain (RBD) antigen. Our sample set included camel sera (both pre- & post outbreak sera), as well as sera from cats and dogs collected at the peak of the pandemic. Our results using the ELISA based on crude SARS-CoV-2 lysate indicated SARS-CoV-2 antibodies in camels (71%, N=145), cats 11% (N=16) and dogs (81%, N=36) with varying titer levels.

Necrotizing pneumonia and severe COVID-19 in an infant with CR-BSI by methicillin-susceptible Staphylococcus aureusGiacomo Brisca1, Silvia Buratti2, Daniela Pirlo1, Luca Basso3, Marta Romanengo1, Maurizio Miano4, Alessio Mesini5, Pietro Salvati6, Andrea Moscatelli1,2, Elio Castagnola5.Sub-Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyNeonatal and Pediatric Intensive Care Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyRadiology Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyHematology Unit, IRCCS Istituto Giannina Gaslini, Genoa, ItalyInfectious Disease Unit, IRCCS IstitutoGianninaGaslini, Genoa, ItalyPneumology Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy

Knowledge of the persistent state of environmental DNA (eDNA) particles in water and modeling its particle size distribution (PSD) is crucial to refine the eDNA sampling strategy. Previous studies measured eDNA concentrations at different size fractions to infer eDNA PSDs, whereas such discrete PSDs greatly depend on filter pore sizes used and may potentially bias our understanding of eDNA states. Here, I evaluated the Weibull distribution model as a tool for parameterizing eDNA PSDs. First, of the selected models developed for PSDs, the Weibull model was fitted most accurately to the eDNA PSD. Second, the Weibull parameters significantly varied depending on target genetic regions (mitochondrial/nuclear), time passages, and species, which also substantially changed the eDNA capture efficiency at a given filter pore size. According to the results, the higher detectability of multi-copy nuclear eDNA than mitochondrial one could partly be accounted for differences in their PSDs, a larger pore size filter could be suitable to detect the eDNA releases associating incidental events, and the optimum filter pore size for sufficient eDNA detection could be different among the taxa. Although further consideration is needed, this study provided the groundwork for optimizing the strategy of aqueous eDNA sampling, which contributes to efficient biodiversity conservation and ecosystem management.

Abstract: Background: Plasma kinins are known for decades but the understanding of them is not up-to the mark and the complexity is the reason. There are many drugs and trials undertaken with these as drug targets but only very few have been successfully marketed and used. Rest all others have resulted in failure during various phases of the trial. Purpose: The purpose of this review is to explain and explore the complexity of plasma kinins and to explore the relations between Kinins and to analyse the failures in drug development with these receptors as targets. Implication: This extensive review might help in understanding the complexity and ensure the reduction of drug development failures in these molecules as drug targets Conclusion: kinins have important role in homeostatic functions of the body physiologically. The pathophysiological roles in inflammation are also known. The complexity of these systems is well established.

Background and purpose: Mutations in the CFTR chloride channel result in intestinal o-structive episodes in cystic fibrosis (CF) patients and in CF animal models. This study explores the possibility of reducing the frequency of obstructive episodes in the Cftr-/- mice by the oral application of a gut selective NHE3 inhibitor tenapanor and searches for the underlying mechanisms involved. Experimental approach: Sex and age-matched Cftr+/+ and Cftr-/- mice were orally gavaged twice daily with 30mgkg-1 tenapanor or vehicle for a period of 21 days. Body weight and stool water content was assessed daily and gastrointestinal transit time (GTT) once weekly. The mice were sacrificed when an intestinal obstruction was suspected or after 21 days, and stool and tissues were collected for further analysis. Key results: 21 day tenapanor application resulted in a significant increase in stool water content, stool alkalinity, and a significant decrease in GTT in Cftr+/+ and Cftr-/- mice. Tenapanor significantly reduced obstructive episodes to 8% compared to 46% in vehicle treated Cftr-/- mice and prevented mucosal inflammation. A decrease in cryptal hyperproliferation, mucus accumulation and mucosal mast cell number was also observed in tenapanor compared to vehicle treated unobstructed Cftr-/- mice. Conclusion and implications: Oral tenapanor application prevented obstructive episodes in CFTR deficient mice and was safe in Cftr+/+ and Cftr-/- mice. These results suggest that tenapanor may be a safe and affordable adjunctive therapy in cystic fibrosis patients to alleviate constipation and prevent recurrent DIOS.

A new test specimen is proposed for investigation of mixed mode I/II/III fracture of materials. In the test specimen, by displacing the position of an inclined crack from the middle of the rectangular specimen, in addition to mode II loading, mixed mode I/III loading conditions are created under anti-symmetric four-point bending. To examine the applicability of the test set-up, the specimens made of PMMA (Polymethyl-methacrylate) with three crack angles and three different positions of crack with reference to the middle of the specimen are tested. The experimental fracture loads are compared with the theoretical predictions of the maximum principal stress fracture criterion. There is a satisfactory consistency between the test and theoretical results. Although the proposed test configuration has limitations in applying the mixed modes of I/III and II/III, it is an efficient test configuration easier and less expensive than other configurations utilizing complex crack geometry or complicated loading fixtures.

Septic arthritis is an inflammatory process involving the joints secondary to an infectious etiology such as bacterial, fungal, mycobacterial, viral, or other pathogens. Septic arthritis of the symphysis of the pubic is a rare cause of hip and pubic pain and is difficult to diagnose.

In this paper, an adaptive sliding mode observer (ASMO) associated with a phase locked loop (PLL) is assessed for the sensor-less control of a rotor-tied doubly-fed induction generator (RDFIG). In the proposed PLL-ASMO estimator, the ASMO utilizes the stator current, the stator voltage and the back electromotive force (EMF) as state variables. The proposed ASMO is used in order to estimate the back-EMF from which the slip position/speed is extracted using a PLL. The design of the ASMO gains is based on the Lyapunov stability criteria to ensure the convergence of the proposed observer in a finite time. Therefore, the main contribution of this paper is to propose a PLL-based ASMO estimator that aims to improve the estimation by reducing the chattering effect. A comparative study between the standard PLL-SMO estimator and the ASMO-PLL estimator is presented. Also, For the first time, an adaptive sliding mode observer is used for the sensor-less control of a RDFIG. The performance of the proposed sensor-less control strategy is validated through simulation and experimental measurements under various operating conditions. Furthermore, the estimator is shown to be robust to machine parameter variation.

Leprosy is a chronic granulomatous disease caused by Mycobacterium leprae. Leprosy occurrence in Saudi Arabia is rare, it was reported that 242 freshly diagnosed leprosy cases were in Saudi Arabia from 2003 to 2012. This report aims to provide awareness, avoid misdiagnosis, and to introduce the manifestations of leprosy.